Electrocardiographic left ventricular hypertrophy criteria and ambulatory blood pressure monitoring parameters in adults

ECG Voltage in Relation to Peripheral and Central Ambulatory Blood Pressure

BACKGROUND

The heart ejects in the central elastic arteries. No previous study in workers described the diurnal profile of central blood pressure (BP) or addressed the question whether electrocardiogram (ECG) indexes are more closely associated with central than peripheral BP.

METHODS

In 177 men (mean age, 29.1 years), we compared the associations of ECG indexes with brachial and central ambulatory BP, measured over 24 hours by the validated oscillometric Mobil-O-Graph 24h PWA monitor.

RESULTS

From wakefulness to sleep, as documented by diaries, systolic/diastolic BP decreased by 11.7/13.1 mm Hg peripherally and 9.3/13.6 mm Hg centrally, whereas central pulse pressure (PP) increased by 4.3 mm Hg (P < 0.0001). Over 24 hours and the awake and asleep periods, the peripheral-minus-central differences in systolic/diastolic BPs averaged 11.8/–1.6, 12.7/–1.8, and 10.3/–1.2 mm Hg, respectively (P < 0.0001). Cornell voltage and index averaged 1.18 mV and 114.8 mV·ms. Per 1-SD increment in systolic/diastolic BP, the Cornell voltages were 0.104/0.086 mV and 0.082/0.105 mV higher in relation to brachial 24-hour and asleep BP and 0.088/0.90 mV and 0.087/0.107 mV higher in relation to central BP. The corresponding estimates for the Cornell indexes were 9.6/8.6 and 8.2/10.5 mV·ms peripherally and 8.6/8.9 and 8.8/10.7 mV·ms centrally. The regression slopes (P ≥ 0.067) and correlation coefficients (P ≥ 0.088) were similar for brachial and central BP. Associations of ECG measurements with awake BP and PP were not significant.

CONCLUSIONS

Peripheral and central BPs run in parallel throughout the day and are similarly associated with the Cornell voltage and index.

Relationships of electrocardiographic parameters with ambulatory hypertension in young and healthy adults

BACKGROUND

Elevated blood pressure (BP) is a leading cardiovascular risk factor and a major determinant of left ventricular mass. Te aim of this study was to assess electrocardiographic (ECG) changes associated with hypertension in a large cohort of young and healthy adults.

METHODS

Healthy individuals aged 25–41 years without known cardiovascular disease were enrolled in a population based cohort study. Resting 12-lead ECG and ambulatory 24-hour BP measurement were obtained using validated devices. Multivariable logistic regression models were constructed to assess the relationships between ECG parameters and daytime hypertension, defined as systolic daytime BP≥140, diastolic BP≥90 mmHg or use of antihypertensive treatment.

RESULTS

Daytime hypertension was present among 430 of 2070 (21%) participants. Significant linear relationships were observed between daytime hypertension with RR interval (odds ratio (OR) 95% confidence interval (CI) 0.84 (0.78; 0.92)), R-wave amplitude in leads I and II (OR (95% CI) 2.04 (1.30; 3.19) and 1.61 (1.15; 2.24), and S-wave amplitudes in leads aVR, V1 and V2 with ORs (95% CI) of 3.28 (1.93; 5.59), 2.15 (1.51; 3.08) and 1.47 (1.18; 1.83), respectively. We also observed linear associations between daytime hypertension and T-wave amplitudes in leads V1 (OR (95% CI) 4.83 (2.35; 9.91)), V2 (2.18 (1.43; 3.32)), V4 (0.48 (0.29; 0.80)) and V5 (0.37 (0.19; 0.72)).

CONCLUSION

Several ECG parameters are independently associated with daytime hypertension among young and healthy adults. This is one of the first studies to show significant relationships between T wave amplitude and hypertension.